Provider Demographics
NPI:1417901752
Name:FOWLER, SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:24 ANTRIM COMMONS DR
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1623
Practice Address - Country:US
Practice Address - Phone:717-597-5553
Practice Address - Fax:717-597-5522
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050738207Q00000X
PAMD430567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415601000Medicaid
MD785200200Medicaid
MDP00150022OtherRAILROAD
MDG31043Medicare UPIN
MD613LMedicare ID - Type UnspecifiedMEDICARE GRP #
MDP00150022OtherRAILROAD
MD613LH397Medicare PIN